title: Percutaneous transluminal valvuloplasty of calcific aortic stenosis in elderly patients. Role of noninvasive evaluation by Doppler echocardiography.
abstract: Between October 1986 and January 1989, 57 attempts of percutaneous transluminal valvuloplasty were made in 51 elderly patients, mean age 76.7 +/- 6.2 years, with symptomatic aortic stenosis; this included 3 failures and 6 repeat valvuloplasties. The procedure resulted in a significant immediate decrease of the peak-to-peak transaortic pressure gradient from 94.6 +/- 26.5 to 42.6 +/- 17.9 mm Hg (p less than 0.002) and an increase of the surface of the aortic valve from 0.4 +/- 0.1 to 0.6 +/- 0.2 cm2 (p less than 0.001). Cardiac output remained unchanged: 3.8 +/- 0.9 vs 3.8 +/- 0.8 lit/min. Complications included local vascular injury requiring surgical repair in 7 patients, cerebral events in 3 patients and disruption of the aortic annulus, the aortic wall and the pulmonary artery each in 1 patient, and resulted in 4 in-hospital deaths (8%). Follow-up data were available for all patients for a mean duration of 12.7 +/- 5.4 months. Fifteen patients (30%) died on average 9.0 +/- 4.9 months after discharge. Recurrence of symptoms and early restenosis were documented in the majority of the patients. Restenosis was successfully treated by repeat valvuloplasty in 4 and by valve replacement in 4 patients. Doppler echocardiography predicted the severity of the aortic stenosis before valvuloplasty and was very useful to assess follow-up results. Because of the limited hemodynamic results, the numerous procedural complications and the development of early restenosis balloon valvuloplasty of aortic stenosis should be restricted to selected symptomatic elderly patients.
authors.affiliation: Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Stammen
authors.forename: J
authors.initials: J
authors.lastname: Piessens
authors.forename: B
authors.initials: B
authors.lastname: Denef
authors.forename: A
authors.initials: A
authors.lastname: Aubert
authors.forename: H
authors.initials: H
authors.lastname: De Geest
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000628:therapy*; D002114:Calcinosis / Q000503:physiopathology / Q000628:therapy*; D002404:Catheterization / Q000379:methods*; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence